Question 1 (Deputy Billy Kelleher)

Question 1 (Deputy Billy Kelleher)

The number of consultant posts which are vacant in publicly-funded hospitals, on an individual basis as well as those which are fill by locums in a temporary capacity; the number of vacancies for nurses and midwives in publicly-funded hospitals; whether any publicly-funded hospitals are facing difficulties in securing the services of non-consultant doctors through employment agencies.

Response:

The HSE pay bill management and control framework which replaced the previous moratorium provisions identifies an overriding requirement for hospitals to operate within notified pay budget and overall net expenditure budgets in 2015.

Vacant Consultant Posts

There are 2,583 Consultant posts, the breakdown of vacancies are as follows:

1. 171 are vacant posts (42 psychiatry posts)
2. This number of vacancies is a reduction of 7 since December 2014. However, in the interim, 48 new posts have been created. In that context, 55 (48+7) of the posts reported as vacant in December have now been filled;
3. This means that for every vacant post which is being recruited/advertised for and filled, another new post is being approved;
4. There are 322 non-permanent consultant posts. Effectively, this indicates that the vast majority of the 171 vacant permanent posts are filled on a temporary / locum basis;
5. The main reasons for employment of a non-permanent Consultant were given by hospitals as:
6. Cover for vacant posts
7. Clinical Director / Medical Director cover
8. Career break cover
9. Support for service pressures
10. Cover for consultants who are seconded to the HSE
11. Waiting list initiatives
12. Implementation of the Rapid Access Prostate clinic (in St. James’s Hospital)
13. Support for the Bowel Screening Programme (in St. James’s Hospital)

Securing the Services of Non Consultant Doctors through Employment Agencies

There are no reported difficulties in securing the services of non-consultant hospital doctors through employment agencies. There are challenges in attracting NCHD’s to some specialised areas, particularly outside Dublin through HSE contracts as potential earnings via agency employment is more attractive for these grades.

Vacant Nursing Posts

HSE HR records as of 10th September 2015 demonstrate that there are 502.6 vacancies for staff nurses in the acute statutory sector. This does not include posts in the acute voluntary sector.

Nurse Recruitment Initiatives - International Campaign There are many initiatives currently underway to improve nursing staff levels throughout the country. These include a focus on the retention of 2015 degree programme graduates and an international recruitment campaign. In addition the conversion of agency usage to permanent staffing in line with agreed processes is a key objective of the National Service Plan 2015.

In July the HSE launched an International Staff Nurse Recruitment Campaign which focused on the UK to attract Staff Nurses to jobs in Ireland. In this campaign there was a particular emphasis on targeting Irish Nurses who have left Ireland in recent years and want to return home. The current relocation is up to €1500 in vouched removal/ relocation expenses including the cost of flights. In addition the Nursing Midwifery Board Ireland registration costs will be paid for.

It is envisaged that the HSE will expand this recruitment initiative outside the UK and Europe in order to fill service vacancies. The Irish Health Service has an excellent reputation for providing quality nursing care and is ideally suited to the development of a rewarding and respected career in nursing. With a recovering economy the Health Service Executive is now in a position to offer a wide range of challenging career opportunities, with many benefits, for nurses and midwives wishing to make a contribution to the health and lives of everyone living in Ireland.

Midwifery

There are areas in which there are challenges regarding the filling of posts for Midwifery and as such efforts are being made to keep all graduates in 2015 and recruitment is ongoing to fill vacant posts. Additional funding of €2.8m was made available in 2015 to address Midwifery posts and recruitment is underway in respect of these posts.

Theatre/Critical Care Nurses – initiatives are also underway to address staffing shortages in relation to Theatre/Critical Care Nurses.

It is difficult to quantify the specific resources that each initiative will yield at this point in time. However, the following is a breakdown of nursing posts for the HSE directly managed services that have been recruited or are currently in the process of recruitment.

There are currently 687 nursing and midwifery post in the process of being recruited.

Question 2 (Deputy Billy Kelleher)

To ask the Minister for Health to detail in tabular format on the basis of each local health areas the number of home help hours provided in 2010; 2011; 2012; 2013, 2014; the number provided to date for each in 2015; and the projection for same for 2015?

Response:

The home help service is a highly valued core community service supporting large numbers of mainly older people to remain in their own homes, preventing admission to acute services, delaying or preventing admission to continuing residential care and facilitating early discharge from the acute sector to the community. The demand for the home help services and for additional supports through the Home Care Package Scheme continues to grow as the population of older people expands and as many more of older people with complex care needs are maintained at home.

Table 1 below sets out the number of mainstream Home Help hours provided

• 2010 - 2014 home help hours provided by LHO &Community Healthcare Organisation(CHO)
• 2015 year to date data by LHO & Community Healthcare Organisation(CHO)
• projected activity to the year end 2015 by LHO & Community Healthcare Organisation(CHO)

The projected outturn for 2015 is 10.447m hours compared to the target of 10.3m hours.

The population aged over 65 years is growing by approximately 20,000 each year, while the over-85 years population, which places the largest pressure on services is growing by some 4% annually. A greater move towards primary and community services, as the principal means to meet people’s home support and continuing care needs is required to address this growing demand and to support acute hospital services.

With increasing numbers of older people and no increase in basic home help hours provided since 2012 due to the economic downturn, the mainstream HH service now focuses on those who are most dependent with service providers allocating available hours over a greater number of people. The requirement to provide more hours at times outside of core hours, in the evenings and at weekends, brings increased costs. The challenge then is to maintain activity in line with targets where the average cost per hour is increasing, due to increasing activity outside of core hours.

In addition, with greater numbers of older very dependent people remaining at home with supports and given our commitment to support acute hospital discharges, two factors begin to impact on service delivery:

• A greater number of people require a HCP because mainstream services alone cannot meet their needs and the number of HCPs approved increases - this can be seen in the numbers of HCPs exceeding target with consequent increased overall expenditure for the HCP scheme.

• Waiting list numbers increase particularly for community based applicants as greater numbers of very dependent people opt to remain at home –

Overall in relation to home care packages the target for this year was 13,200 while service delivery has exceeded 14,000 to the present date. It is important to note also that the service plan this year provided an additional €5m for home care package (as part of the €25m delayed discharges initiative) with over 400 home care packages provided to the benefit of 600 additional older people. Furthermore as part of the €74m allocation a further €4m has been spent on home care packages benefiting a further 300 people.

The system taking all of the above into account is focused on managing the total home care resource across HH/ HCP across the Community Healthcare Organisation (CHO) and a national level in a way which meets the priority needs and in a way that spreads the resource throughout the year. Based on activity year to date it is expected that the National Service Plan targets for both HH and HCP will be achieved and in particular in relation to HCPs the target will be exceeded.

CHO / LHO / 2010 / 2011 / 2012 / 2013 / 2014 / 2015 YTD (May 2015) / Projected Activity to end 2015 / Target 2015
HH Hours / HH Hours / HH Hours / HH Hours / HH Hours / HH Hours / HH Hours / HH Hours
CHO 1 / Cavan Monaghan / 548,094 / 435,744 / 347,988 / 318,505 / 331,209 / 124,589 / 313,000 / 335,000
Donegal / 607,617 / 638,847 / 624,554 / 569,581 / 609,783 / 257,521 / 627,000 / 602,000
Sligo/ Leitrim / 440,183 / 418,552 / 412,508 / 373,839 / 402,925 / 173,125 / 424,000 / 399,000
CHO Total / 1,595,894 / 1,493,143 / 1,385,050 / 1,261,925 / 1,343,917 / 555,235 / 1,364,000 / 1,336,000
CHO 2 / Galway / 629,019 / 674,363 / 620,811 / 605,032 / 639,502 / 221,177 / 591,000 / 655,000
Mayo / 408,789 / 407,066 / 379,895 / 338,206 / 360,175 / 165,029 / 400,000 / 348,000
Roscommon / 230,387 / 241,947 / 218,132 / 217,129 / 231,948 / 97,420 / 238,000 / 229,000
CHO Total / 1,268,195 / 1,323,376 / 1,218,838 / 1,160,367 / 1,231,625 / 483,626 / 1,229,000 / 1,232,000
CHO 3 / Clare / 181,529 / 178,319 / 168,342 / 187,619 / 195,278 / 82,034 / 203,000 / 190,600
Limerick / 524,671 / 390,782 / 380,455 / 364,543 / 387,381 / 154,108 / 381,000 / 380,700
North Tipp/East Limerick / 310,489 / 323,739 / 320,429 / 308,839 / 312,855 / 137,651 / 340,000 / 310,500
CHO Total / 1,016,689 / 892,840 / 869,226 / 861,001 / 895,514 / 373,793 / 924,000 / 881,800
CHO 4 / Kerry / 765,800 / 747,006 / 548,718 / 525,117 / 567,300 / 221,521 / 610,000 / 587,000
North Cork / 426,611 / 435,944 / 410,712 / 384,221 / 414,207 / 157,193 / 421,000 / 417,500
North Lee / 515,952 / 456,240 / 444,414 / 414,190 / 461,972 / 168,466 / 446,000 / 464,500
South Lee / 461,298 / 442,792 / 457,470 / 416,234 / 460,385 / 170,154 / 467,000 / 465,000
West Cork / 272,394 / 274,080 / 249,888 / 299,555 / 333,958 / 122,398 / 337,000 / 338,000
CHO Total / 2,442,055 / 2,356,062 / 2,111,202 / 2,039,317 / 2,237,822 / 839,732 / 2,381,000 / 2,272,000
CHO 5 / Carlow/ Kilkenny / 374,811 / 352,130 / 289,278 / 310,127 / 305,950 / 128,818 / 297,000 / 311,000
South Tipperary / 436,026 / 403,398 / 303,698 / 285,704 / 294,636 / 121,115 / 291,000 / 297,000
Waterford / 221,046 / 313,313 / 310,826 / 230,926 / 263,245 / 105,000 / 256,000 / 259,000
Wexford / 386,522 / 352,827 / 360,647 / 353,738 / 368,464 / 149,618 / 359,000 / 369,000
CHO Total / 1,418,405 / 1,421,668 / 1,264,449 / 1,180,495 / 1,232,295 / 504,551 / 1,203,000 / 1,236,000
CHO 6 / Dublin South East / 110,358 / 104,179 / 114,403 / 118,135 / 105,585 / 34,395 / 87,000 / 108,000
Dun Laoghaire / 112,726 / 85,992 / 85,520 / 79,215 / 81,002 / 32,805 / 80,000 / 81,000
Wicklow / 269,860 / 250,041 / 225,149 / 207,016 / 216,996 / 88,523 / 213,000 / 214,800
CHO Total / 492,944 / 440,212 / 425,072 / 404,366 / 403,583 / 155,723 / 380,000 / 403,800
CHO 7 / Dublin South City / 154,109 / 144,883 / 150,265 / 121,864 / 111,295 / 48,108 / 116,000 / 110,600
Dublin South West / 193,843 / 184,672 / 171,293 / 158,967 / 146,421 / 53,635 / 133,000 / 145,000
Dublin West / 286,660 / 259,881 / 232,302 / 226,671 / 202,809 / 73,692 / 178,000 / 207,000
Kildare/ West Wicklow / 363,346 / 359,328 / 289,159 / 280,694 / 266,157 / 115,808 / 280,000 / 264,000
CHO Total / 997,958 / 948,764 / 843,019 / 788,196 / 726,682 / 291,243 / 707,000 / 726,600
CHO 8 / Laois/ Offaly / 286,148 / 286,779 / 242,770 / 224,061 / 263,639 / 115,921 / 285,000 / 269,000
Longford/ Westmeath / 286,632 / 330,922 / 290,715 / 244,922 / 242,426 / 100,782 / 238,000 / 242,000
Louth / 263,038 / 205,779 / 169,069 / 184,069 / 216,265 / 90,499 / 220,000 / 214,000
Meath (2010 incl some HCP Hrs) / 463,634 / 335,454 / 375,355 / 396,302 / 459,639 / 199,358 / 481,000 / 458,000
CHO Total / 1,299,452 / 1,158,934 / 1,077,909 / 1,049,354 / 1,181,969 / 506,560 / 1,224,000 / 1,183,000
CHO 9 / Dublin North / 420,421 / 351,911 / 229,957 / 362,950 / 437,327 / 200,772 / 489,000 / 425,000
Dublin North Central / 580,477 / 536,432 / 311,054 / 375,357 / 361,344 / 153,858 / 380,000 / 356,000
Dublin North West / 148,027 / 169,096 / 151,953 / 254,691 / 246,404 / 108,082 / 266,000 / 247,800
CHO Total / 1,148,925 / 1,057,439 / 692,964 / 992,998 / 1,045,075 / 462,712 / 1,135,000 / 1,028,800
Total / 11,680,516 / 11,092,436 / 9,887,726 / 9,738,017 / 10,298,481 / 4,173,175 / 10,447,000 / 10,300,000

Table 1: Home Help Hours provided (excluding Home Care Package Hours)

Question 3 (Senator Thomas Byrne)

To ask the Minister for Health to detail in tabular format on the basis of each local health areas the number of personal assistant hours provided to people with disabilities in 2010; 2011; 2012; 2013, 2014; the number provided to date for each in 2015; and the projection for same for 2015; the number of people with disabilities who have applied for and are currently awaiting the provision of a Personal Assistant service and if he would provide such information on the basis of waiting 0-3 months; 3-6 months; 6-9 months; 9-12 months; greater than 12 months?

Response:

The HSE provides arange of assisted living services including Personal Assistant services to support individuals to maximise their capacity to live full and independent lives. While the resources for the provision of assisted living services available are substantial they are finite.

The role of a Personal Assistant (PA) is to assist a person with a disability to maximise their independence through supporting them to live in integrated settings and to access community facilities. The PA works on a one to one basis, in the home and /or in the community, with a person with a physical or sensory disability. A vital element of this personalised support is the full involvement of the individual (service user) in planning and agreeing the type and the times when support is provided to them.Supporting independent living must enhance the person’s control over their own life.

In the 2015 National Service Plan, the HSE’s priority is to provide 1.3 million hours of personal assistance to adults with a physical/sensory disability. The HSE is on track to exceed this target.

The table below provides the number of PA Services hours delivered to people with a disability in 2013, 2014 and to date in 2015, together with the projected outturn for 2015. Please note that Data definitions have been refined over the last number of years and therefore it is difficult to provide accurate comparisons in relation to the number of hours of Personal Assistant services, particularly from 2008-2012.

Number of PA Service Hours Delivered to People with a Physical and/or Sensory Disability

CHO / LHO / 2013 / 2014 / 2015 to date
(Q1 and Q2) / Projected Outturn 2015
(based on Q1 and Q2 2015)
National Total / 1,291,070 / 1,335,759 / 725,199 / 1,450,400
CHO 1 / Total / 124,269 / 125,981 / 68,184 / 136,368
Cavan Monaghan / 3,060 / 3,060 / 1,530 / 3,060
Sligo Leitrim / 64,086 / 68,834 / 37,198 / 74,396
Donegal / 57,123 / 54,086 / 29,456 / 58,912
CHO 2 / Total / 227,461 / 241,670 / 148,516 / 297,032
Galway / 158,567 / 170,170 / 85,183 / 170,366
Roscommon / 51,788 / 51,907 / 26,336 / 52,672
Mayo / 17,106 / 19,593 / 36,997 / 73,994
CHO 3 / Total / 291,879 / 273,959 / 139,864 / 279,730
North Tipperary East Limerick / 92,897 / 91,773 / 43,169 / 86,340
Limerick / 90,833 / 84,133 / 34,735 / 69,470
Clare / 108,149 / 98,054 / 61,960 / 123,920
CHO 4 / Total / 117,773 / 115,019 / 59,985 / 119,970
North Lee / 36,233 / 36,142 / 19,598 / 39,196
West Cork / 12,913 / 15,829 / 7,333 / 14,666
Kerry / 9,915 / 39,828 / 20,342 / 40,684
North Cork / 21,278 / 22,091 / 12,120 / 24,240
South Lee / 37,434 / 1,129 / 592 / 1,184
CHO 5 / Total / 63,432 / 95,496 / 50,006 / 100,012
Wexford / 3,792 / 2,528 / 281 / 562
Waterford / 14,606 / 17,166 / 8,848 / 17,696
Carlow Kilkenny / 45,010 / 64,602 / 33,842 / 67,684
South Tipperary / 24 / 11,200 / 7,035 / 14,070
CHO 6 / Total / 49,806 / 24,243 / 10,799 / 21,598
Dublin South East / 38,088 / 12,055 / 4,751 / 9,502
Wicklow / 7,902 / 8,986 / 4,464 / 8,928
Dun Laoghaire / 3,816 / 3,202 / 1,584 / 3,168
CHO 7 / Total / 15,723 / 16,916 / 13,512 / 27,024
Dublin South West / 3,640 / 5,262 / 3,920 / 7,840
Dublin West / 12,083 / 11,654 / 7,715 / 15,430
Dublin South City / 0 / 0 / 1,877 / 3,754
Kildare West Wicklow / 0 / 0 / 0 / 0
CHO 8 / Total / 118,321 / 152,582 / 77,972 / 155,942
Louth / 0 / 0 / 0 / 0
Longford Westmeath / 49,448 / 61,460 / 31,253 / 62,506
Meath / 483 / 1,911 / 859 / 1,718
Laois Offaly / 68,390 / 89,211 / 45,860 / 91,718
CHO 9 / Total / 282,407 / 289,894 / 156,362 / 312,724
Dublin North West / 1,921 / 1,885 / 4,827 / 9,654
Dublin North Central / 229,274 / 238,371 / 125,643 / 251,286
Dublin North / 51,212 / 49,638 / 25,892 / 51,784

Services are accessed through an application process or through referrals from public health nurses or other community based staff. Individuals’ needs are evaluated against the criteria for prioritisation for the particular service and then decisions are made in relation to the allocation of resources. Resource allocation is determined by the needs of the individual, compliance with prioritisation criteria, and the level of resources available.

In the normal course of service delivery, there will be ongoing reviews throughout the year to ensure that if needs change the service provided will address this change within available resources. An individual’s PA hours may be adjusted following a service review where service demand can result in one individual’s service being reduced in order to address priority needs of other people with disabilities within that community.

The National Physical and Sensory Disability Database report (NPSDD 2013) provides a profile of 24,391 individuals with a Physical and / or Sensory disability. It details the specialised health and personal social services provided and an outline of future needs. Currently in excess of 2,300 adults receive a PA service which on average equates to 11 hours per week. However it should be noted that 83 are in receipt of 60+ hours per week and some availing of 16 hours per day and almost 1500 in receipt of less than 10 hours per week. With the information available from the NSPDD and locally in excess of 291 are listed as awaiting such services.

Each of these individuals will require a minimum of 30 hours a weekat a costs of approx €10m annually. By way of illustration of the scale of resources required to meet the full level of emerging needs, a recent analysis has shown that a small number of people with disabilities will require up to 16 hours a day support and some are seeking 24/7 support. The cost of providing 50 additional people with this level of support will cost in excess of €6m annually.

Question 4 (Senator Thomas Byrne)

To ask the Minister for Health if he will detail in tabular format the public or voluntary hospitals that carry out MRI scans; the number of people waiting as of September 1 2015 or the nearest available date for such a procedure at each of the hospitals in the following waiting periods; less than three months; three months to six months; six months to nine months; nine months to twelve months; more than twelve months; and if he will also provide the same detail for CT Scans.

Response:

The HSE faces important challenges in addressing its diagnostic waiting lists, as referrals have increased significantly. In this context, two national data collection projects are in train.

The Inpatient Diagnostics Project for the collection of inpatient waiting times and activity for diagnostics is in the process of defining and agreeing specifications and has taken some time to progress due to complexities around data protection and patient confidentiality. It is important that all aspects, including data protection and patient confidentiality and data governance, are adequately covered to reduce issues of comparability when data comes to be recorded at all sites. As part of the scoping stage, a detailed specification for the Minimum Data Set is currently being developed and reviewed.

As mentioned above, the programme will work with the various stakeholders to develop a set of performance targets to be included in the 2016 service plan.

In addition the HSE Primary Care Division has initiated a pilot project with regard to GP Direct access for ultrasounds which is due to commence in September 2015.

While waiting times for diagnostics are not currently included, the HSE plans to begin national collection of standardised and comparable data from 2016.

The tables below list the public or voluntary hospitals that carry out MRI and CT Scans.

Hospitals providing CT scans
St. Vincent's University Hospital Elm Park
St. Luke's Hospital Kilkenny
Our Ladys Hospital - Navan
Wexford General Hospital
Mater Misericordiae University Hospital
Midland Regional Hospital Mullingar
St. Columcille's Hospital Loughlinstown
Naas General Hospital
Midland Regional Hospital - Tullamore
Midland Regional Hospital - Portlaoise
St. Luke's Hospital Rathgar
AMNCH, Tallaght (Adults & Paediatrics Combined)
St. James's Hospital
Cavan and Monaghan Hospital
Our Lady of Lourdes Hospital Drogheda
Louth County Hospital
Connolly Hospital - Blanchardstown
Beaumont Hospital
Our Lady's Children's Hospital Crumlin
Children's University Hospital Temple Street
Cork University Maternity Hospital
Waterford Regional Hospital
Mercy University Hospital Cork
Cork University Hospital (including CUMH Data)
Kerry General Hospital
Bantry General Hospital
Mallow General Hospital
South Infirmary University Hospital Cork
South Tipperary General Hospital
Mid Western Regional Hospital Dooradoyle
Mid Western Regional Hospital Nenagh
St. John's Hospital Limerick
Mid Western Regional Hospital Ennis
Portiuncula Hospital General & Maternity Balinasloe
Letterkenny General Hospital
Sligo General Hospital
University Hospital Galway
Roscommon County Hospital
Mayo General Hospital
Hospitals providing MRI scans
St. Vincent's University Hospital Elm Park
St. Luke's Hospital Kilkenny
Mater Misericordiae University Hospital
Naas General Hospital
AMNCH (Adults & Paeds combined)
Midland Regional Hospital - Tullamore
Midland Regional Hospital - Portlaoise
St. Luke's Hospital Rathgar
St. James's Hospital
Cavan and Monaghan Hospital
Our Lady of Lourdes Hospital Drogheda
Connolly Hospital - Blanchardstown
Beaumont Hospital
Our Lady's Children's Hospital Crumlin
Children's University Hospital Temple Street
Waterford Regional Hospital
Mercy University Hospital Cork
Cork University Hospital, including Cork University Maternity Hospital
Kerry General Hospital
South Infirmary University Hospital Cork
Mid Western Regional Hospital Dooradoyle
Portiuncula Hospital General & Maternity Balinasloe
Letterkenny General Hospital
Sligo General Hospital
University Hospital Galway
Mayo General Hospital

Question 5 (Senator Thomas Byrne)